Provider Demographics
NPI:1255521209
Name:ROBERT R CROFT INC
Entity type:Organization
Organization Name:ROBERT R CROFT INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:R
Authorized Official - Last Name:CROFT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:209-524-5515
Mailing Address - Street 1:1236 FLOYD AVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95350-2471
Mailing Address - Country:US
Mailing Address - Phone:209-524-5515
Mailing Address - Fax:209-524-5683
Practice Address - Street 1:1236 FLOYD AVE
Practice Address - Street 2:SUITE C
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95350-2471
Practice Address - Country:US
Practice Address - Phone:209-524-5515
Practice Address - Fax:209-524-5386
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-26
Last Update Date:2007-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA200931223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB20093OtherDENTICAL